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Atypical liver hemangiomas?


greenbeanie

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greenbeanie Enthusiast

Hi folks! I haven't posted in a while because my daughter and I are both doing great since we removed a few certified gluten free products from our diet last spring that had trace gluten below 20ppm. In a roundabout way the rise and fall of my daughter's blood tests along with my reaction to trace gluten cc (before we knew there was any) and quick disappearance of fat malabsorption after eliminating those products actually led my GI doctor to give me an official celiac diagnosis on clinical grounds even though I did not meet the usual diagnostic criteria. So I am now getting proper follow-up, which is great. 

 
However, one consequence of this is that my doctors are taking a harder look at a variety of minor/moderate abnormalities that had come up on various tests in the past, which they had dismissed as inconsequential at the time. I have two small lesions on my liver, one of which has been confirmed as an atypical hemangioma and has remained stable in size. The other lesion may also be an atypical hemangioma or adenoma, but neither ultrasound nor MRI could get a clear picture of it. An abdominal CT scan is recommended, but I've had multiple CT scans and other high-radiation tests over the past ten years, and I'm reluctant to get another one when the lesion is almost certainly benign and the CT scan might not even get a better picture of it than the MRI anyway. My liver is otherwise normal in size and appearance, though I do have a couple small cysts on my spleen too that they are not concerned about. My recent liver panel showed normal enzymes and other blood tests. I had a positive ANA in the past that has normalized too. I have no symptoms, and the liver lesions were an incidental finding from my GI's original work-up a couple years ago. I'm seeing a liver specialist in a few weeks. Meanwhile, I did find a recent article about an association between celiac and hepatic hemangiomas:
 
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Has anyone had a similar experience with multiple atypical hemangiomas or adenomas? Did they grow or shrink over time? Suggestions for what questions I should ask the liver specialist? 
 
After so many years of trying to get doctors to take my concerns seriously, it's odd to be in a position where I actually feel sure that the rest of the weird stuff isn't serious and will keep improving with time, whereas my doctors are suddenly treating everything as significant. Both liver lesions are small (less that 1.5cm). I obviously don't want to ignore a problem that really could be serious, but I also don't want to have unnecessary high-radiation tests. 

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    • Samanthaeileen1
      thank you RMJ! That is very helpful advice. Good to know we aren’t crazy if we don’t do the endoscopy. We are going to try the gluten free and see how symptoms and levels improve.    thank you Wheatwacked (love the username lol) that is also reassuring. Thankfully she has an amazing and experienced pediatrician. And yesss I forgot to mention the poop! She has the weirdest poop issues.    How long did it take y'all to start seeing improvement in symptoms? 
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      So her tissue transglutaminase antibody is almost 4x the upper end of the normal range - likely a real result. The other things you can do besides an endoscopy would be: 1.  Genetic testing.  Unfortunately a large proportion of the population has genes permissive for celiac disease, but only a small proportion of those with the genes have it. With family history it is likely she has the genes. 2.  Try a gluten free diet and see if the symptoms go away AND the antibody levels return to normal. (This is what I would do). Endoscopies aren’t always accurate in patients as young as your daughter. Unfortunately, without an endoscopy, some doctor later in her life may question whether she really has celiac disease or not, and you’ll need to be a fierce mama bear to defend the diagnosis! Be sure you have a good written record of her current pediatrician’s diagnosis. Doing a gluten challenge for an endoscopy later in life could cause a very uncomfortable level of symptoms.   Having yourself, your husband and your son tested would be a great idea.  
    • Samanthaeileen1
      here are the lab ranges.  Normal ranges for tissue transglutaminase are: <15.0 Antibody not detected > or = 15.0 Antibody detected normal for endomysial antibody is < 1.5. So she is barely positive but still positive. 
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